Restless Legs Syndrome

What is Restless legs syndrome?

Restless legs syndrome (RLS, also called Willis–Ekbom disease) causes uncomfortable, hard-to-describe sensations in the legs together with an irresistible urge to move them. People describe it as “creeping”, “crawling”, “pulling”, “electric” or “an itch inside the bones”. Symptoms begin when resting, especially in the evening and at night, and are temporarily relieved by walking or moving the legs.

RLS is common and affects women more often. Changes in the brain’s dopamine system and iron deficiency in the brain play a central role. It often runs in families, particularly when it starts at a young age.

RLS is more common with — or triggered by — iron deficiency, pregnancy (especially the last three months), kidney failure and dialysis, peripheral neuropathy and certain medicines (some antidepressants, antihistamines and anti-sickness drugs). Most people with RLS also have periodic limb movements — repeated leg jerks during sleep.

Periodic limb movements in sleep

Most people with RLS have involuntary leg movements every 20–40 seconds during sleep, bending at the ankle and knee. They usually do not notice them, but the movements fragment sleep and cause unrefreshing sleep and daytime fatigue. A partner may notice kicking at night. These movements are measured with polysomnography.

Symptoms of Restless legs syndrome

• Unpleasant sensations in the legs (sometimes the arms) with an urge to move
• Symptoms that start when sitting or lying still
• Temporary relief from walking, stretching or rubbing the legs
• Symptoms that are clearly worse in the evening and at night and ease in the morning
• Difficulty falling asleep and frequent awakenings
• Leg jerks during sleep noticed by a partner
• Difficulty sitting through long journeys, films or meetings
• Daytime tiredness and sleepiness

When should you see a neurologist?

An assessment is recommended if these symptoms occur several times a week, disturb your sleep or affect your quality of life — particularly if:

• Leg symptoms start or worsen during pregnancy
• You have kidney disease or are on dialysis
• You have iron-deficiency anaemia or donate blood often
• Treatment that used to work now brings symptoms on earlier in the day or into the arms (augmentation)
• Leg restlessness comes with numbness and burning in the feet (possible neuropathy)

How is Restless legs syndrome diagnosed?

RLS is diagnosed mainly from your description, looking for four key features: an urge to move the legs, starting or worsening at rest, relief with movement and worsening in the evening and night. Conditions that mimic it — leg cramps, varicose veins, joint pain and neuropathy — are ruled out by examination.

• Blood tests: ferritin (iron stores), serum iron, transferrin saturation, full blood count, kidney function, B12, folate, thyroid and blood glucose
• EMG: if numbness and burning in the feet suggest neuropathy
• Polysomnography: if the diagnosis is uncertain, to measure periodic limb movements and their effect on sleep, or if sleep apnea is suspected

Ferritin is particularly important: some values considered “normal” on routine blood tests are too low for people with RLS.

Conditions that can feel similar

• Night-time leg cramps: sudden painful tightening that eases with stretching, without the urge to move
• Peripheral neuropathy: burning and numbness that persist during the day and do not ease with movement
• Varicose veins and circulation problems: heaviness that worsens with standing
• Joint pain: worse with movement, better with rest
• Positional discomfort: disappears completely with a change of position

How is Restless legs syndrome treated?

Correcting iron deficiency

If ferritin is low, iron replacement is the first step — by mouth or, when necessary, intravenously. Symptoms improve considerably in many people once iron stores are replenished.

Non-drug measures

• Regular sleep times and enough sleep
• Avoiding caffeine, alcohol and smoking in the evening
• Regular moderate exercise and leg stretches before bed
• Reviewing medicines that may worsen symptoms
• Keeping the mind busy in the evening (puzzles, reading)
• A warm shower or leg massage

Medication

For frequent symptoms affecting quality of life, medication is used. Medicines that reduce nerve over-excitability (alpha-2-delta ligands) are now often preferred first. Medicines acting on the dopamine system are also effective, but with long-term use they can cause augmentation — symptoms starting earlier and becoming stronger — so they are used at low doses and with care. Other drug groups may be added by a specialist in resistant cases.

Treatment timeline and your stay in Istanbul

The first consultation takes 30–45 minutes and blood tests can be taken the same day; if a sleep study is needed, one night is arranged. Iron treatment is assessed over weeks to months; medication effects usually within days to weeks.

For patients from abroad, the consultation, blood tests and — if needed — a sleep study fit into 1–2 days in Istanbul; results and dose adjustments can be followed online.

Follow-up after treatment

• Ferritin is checked at regular intervals
• Note the time symptoms start and how strong they are; earlier onset or spread to the arms may signal augmentation
• Tell any doctor prescribing a new medicine that you have RLS
• If you are planning a pregnancy, review your medicines in advance

Risks and what to watch for

RLS is not life-threatening, but by disturbing sleep it can cause daytime fatigue, low mood and reduced quality of life. Medicines can cause drowsiness, dizziness, nausea or weight gain. Long-term use of dopamine-acting medicines can lead to augmentation and, rarely, impulse-control problems (excessive shopping, gambling); regular follow-up is therefore important. Intravenous iron rarely causes allergic reactions.

Frequently asked questions about Restless legs syndrome